| NPI | 1427492503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2021-02921) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 54872) |
| 207Q00000X Family Medicine (Licence: GA 76497) | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2023-07-24 |